Joyce Cappiello

Essential Competencies in Nursing Education for Prevention and Care Related to Unintended Pregnancy

OBJECTIVES To identify the essential competencies for prevention and care related to unintended pregnancy to develop program outcomes for nursing curricula. DESIGN Modified Delphi study. SETTING National. PARTICIPANTS Eighty-five nurse experts, including academic faculty and advanced practice nurses providing sexual and reproductive health care in primary or specialty care settings. METHODS Expert panelists completed a three-round Delphi study using an electronic survey. RESULTS Eighty-five panelists completed the first round survey, and 72 panelists completed all three rounds. Twenty-seven items achieved consensus of at least 75% of the experts by the third round to comprise the educational competencies. CONCLUSION Through an iterative process, experts in prevention and care related to unintended pregnancy reached consensus on 27 core educational competencies for nursing education. The competencies provide a framework for curricular development in an important area of nursing education.

Core competencies in sexual and reproductive health for the interprofessional primary care team

OBJECTIVE A primary care workforce that is well prepared to provide high-quality sexual and reproductive health (SRH) care has the potential to enhance access to care and reduce health disparities. This project aimed to identify core competencies to guide SRH training across the primary care professions. STUDY DESIGN A six-member interprofessional expert working group drafted SRH competencies for primary care team members. Primary care providers including family physicians, nurses, nurse practitioners and certified nurse midwives, physician assistants and pharmacists were invited to participate in a three-round electronic Delphi survey. In each round, participants voted by email to retain, eliminate or revise each competency, with their suggested edits to the competencies incorporated by the researchers after each round. RESULTS Fifty providers from six professions participated. In Round 1, 17 of 33 draft competencies reached the 75% predetermined agreement level to be accepted as written. Five were combined, reducing the total number to 28. Based on Round 2 feedback, 21 competencies were reworded, and 2 were combined. In Round 3, all 26 competencies reached at least 83.7% agreement, with 9 achieving 100% agreement. CONCLUSION The 33 core competencies encompass professional ethics and reproductive justice, collaboration, SRH services and conditions affecting SRH. These core competencies will be disseminated and adapted to each professions scope of practice to inform required curricula. IMPLICATIONS SRH competencies for primary care can inform the required curricula across professions, filling the gap between an established standard of care necessary to meet patient needs and the outcomes of that care.

Bring the Popcorn: Using Film to Teach Sexual and Reproductive Health

The use of film as a teaching modality offers an opportunity for nursing students to explore the intersections of science, theory, and personal values prior to caring for clients with sexual and reproductive health (SRH) needs. Although the use of a broad range of arts and humanities modalities in the classroom is described in the literature, the use of film in relationship to teaching SRH has not been explored. Furthermore, there is a paucity of literature regarding the didactic or clinical teaching of SRH in nursing education. This article provides a framework for incorporating film as a teaching strategy into both case-based and problem-based teaching pedagogies. Reviews and discussion questions of films are provided.

Clinical issues in post-abortion care.

This article provides an overview of the clinical issues in post-abortion care, including types of abortion procedures, expected post-abortion course, possible complications, and the components of the post-abortion visit. By providing follow-up care to their patients, NPs can increase continuity of care and promote successful contraceptive use.

Systematic Review of Sexual and Reproductive Health Care Content in Nursing Curricula

Objective To examine whether and to what extent pre‐licensure nursing programs include sexual and reproductive health (SRH) content in their curricula. Data Sources Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, Science Direct, Google Scholar, ProQuest, and CAB Direct were searched for relevant literature. We also reviewed the reference lists of all studies, nursing organization Web sites, and the personal files of the authors. Study Selection Inclusion criteria were studies focused on SRH content in pre‐licensure nursing education, written in English, and published between January 1990 and November 2016. We identified 632 articles, and of these, 22 met the inclusion criteria. Duplicates were discarded, and 13 articles were reviewed (9 quantitative descriptive, 2 modified Delphi, 2 mixed methods). Data Extraction Data extraction and subsequent analysis were guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Data were extracted and organized under the following headings: author and year to establish a historical timeline, study purpose and design, sample size, data collection methods, main study findings, and limitations. Data Synthesis We found the following: (a) most studies focused on baccalaureate education; if associated degree programs were reviewed, findings were not reported separately; (b) definitions were not consistent, which affected the scope of study results; (c) the SRH topics taught were similar; (d) there is a recent interest in sexual orientation and gender identity curriculum; (e) barriers to including content were time constraints, competing demands with other curriculum priorities, and a need for creative curriculum tools. Conclusion Documentation of SRH content in pre‐licensure nursing education is limited. Faculty should conduct ongoing evaluation of their curricular strategies and clinical experiences and publish results in the literature.

SRH Workforce Summit: now is the time to bring sexual and reproductive health to primary care.

SRH Workforce Summit: now is the time to bring sexual and reproductive health to primary care Joyce Cappiello⁎, Melissa Nothnagle Reproductive Options Education Consortium for Nursing (The ROE Consortium), Provide, Cambridge, MA 02141, USA Department of Family Medicine, Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA Received 18 May 2013; revised 1 June 2013; accepted 4 June 2013

THE REBIRTH OF THE CERVICAL CAP

In an effort to dispel myths surrounding the cervical cap, the historical and political factors affecting the caps use in the U.S. are described. Clinical aspects of cap fitting are also included. The cervical cap has found only limited acceptance in the U.S. Skepticisms on the part of physicians may be the result of 2 factors: confusion of the cervical cap with intracervical devices used for artificial insemination and confusion with stem pessaries; and the lack of clinical research and statistical evaluation of efficacy rates. The latter factor prompted Tietze et al. to conduct the only U.S. statistical study of the cap in 1953. Of the 143 women studied, the pregnancy rate was 7.6/100 years of use. Of the 28 unplanned pregnancies, 6 were related to faulty technique or omission of a spermicide and 10 were instances of admittedly irregular use. When these failures are omitted, the theoretical effectiveness rate is about 98%. Some practitioners are concerned about an increased incidence of cervical erosion with cap use. Possibly currently conducted studies will show that cap and spermicide users have a lower incidence of cervical erosion than women using no contraceptive method. Study findings suggest that the cervical cap may afford protection without any spermicidal supplement, but the use of spermicides continues to be recommended to clients. Advantages of the cervical cap include the following: it can be left in place longer than a diaphragm without additional applications of spermicide in the vagina; and the insertion of the cap is unrelated to the time of intercourse. Despite research on toleration of the cap for 3 weeks at a time, it is recommended that the cap be worn for only a few days at a time. At this time there are no manufacturers of cervical caps for contraceptive use in the U.S. The cap is now being imported from England and it costs

The Annual Gynecologic Examination Updated for the 21st Century

6.00. A factor that has made the cap unpopular with many physicians is the lengthy time required for fitting. An assessment guide that physicians can use to incorporate cervical caps in their practice is included. The guide covers medical/gynecological history; informed consent; pelvic examinations; assessment; fitting the cap; and instructing the client. Instructions for client use are also outlined.

The Updated, Annual, Gynecologic Examination

The concept of an annual gynecologic screening visit to identify disease at an early stage has long been an established component of womens health care. Women and their health care providers have historically accepted the schedule of an annual gynecologic examination with cervical cancer screening and a pelvic examination. Recently, researchers questioned the value of the annual breast and pelvic examinations in asymptomatic women and re-established the intervals for Pap test screening with the addition of human papillomavirus co-testing to establish cervical cancer risk. The updated well woman examination is now an opportunity to engage women in health education, screening for chronic disease risks, and health care concerns such as depression and violence.

IUDs: beyond the basics.

Poster Presentation Background The practice of annual gynecologic screening to identify problems at an early stage for intervention has traditionally been a component of womens health care. Patients and providers have accepted the schedule of these examinations, which includes cervical cancer screening and a pelvic examination. However, there is little evidence to support the benefits of such annual screening in low risk women. The Institute of Medicine (IOM), the Centers for Disease Control and Prevention, and the Office of Population Affairs (OPA) have developed recommendations for providing essential preventive services for women. Other professional organizations provide evidence‐based guidelines for cervical cancer screening. The American College of Physicians currently recommends against performing screening pelvic examination in asymptomatic, nonpregnant, adult women. The American College of Obstetricians and Gynecologists (ACOG) further states that no evidence supports or refutes the annual pelvic examination and its performance should be based on shared decision making. Case Lucia, a 31‐year‐old healthy woman presented for her annual gynecologic examination. Her past history included negative annual Pap smears since age 18. As the office nurse or advance practice nurse using the most current evidence, what is the appropriate cervical cancer screening interval, and is a pelvic examination indicated? This poster presentation reviews current evidenced‐based recommendations for womens preventative health care, changes in cervical cancer screening protocols, and the evidence for the screening pelvic examination. The components of an evidence‐based, womens wellness visit is presented. Conclusion The wellness examination should be based on evidence‐based recommendations. In addition to breast and cervical cancer screening, this includes risk assessment for sexually transmitted infections, assessment of sexual wellness, screening for intimate partner violence, immunization review, and assessment of overall health and wellness. Preventive services should include pregnancy prevention with a focus on preconception care or options counseling if indicated. The prevention of chronic diseases through modifiable risks factors is stressed. The nursing profession has a long history of incorporating evidence‐based science into daily practice and of challenging long‐accepted patterns of providing care. A critical appraisal and redesign of the structure of the annual gynecologic examination can strengthen efforts to promote the overall health of women. Nurses can take leadership roles within the health care team to change protocols based on the best available evidence. After a careful review of Lucias health history, she is eligible for Pap and human papilloma virus (HPV) cotesting every 5 years without a pelvic examination at todays visit.